HERBIE1

The big problem is that where fire based EMS exists, they are the dominant provider in terms of volume, money, and political clout. That means any solution offered could not portray that dominant organization in a bad light.

2010 was awesome. The books are actually much better than the movies. Usually are.

Need to be specific. There are studies related to stress, sleep deprivation, etc.

Welcome!

I was recently reading up on a topic for my students and ran across this info. Interesting to say the least. I brought it up to my students and asked them about the potential impact on an EMS system if BP's cut off point changes for a trauma center transport. We came up with quite a list. Sounds like they need to do more research- as in what type of patients would this affect, etc.

After seeing the replies and the added info like ambient temp, I am more likely to think dehydration. Hyperglycemia, heat(remember, heat effects are cumulative), and the fact that many older folks are chronically dehydrated, I'm leaning towards cramps due to dehydration. Good thread. It's fun playing detective- one of my favorite parts of the job. Maybe I'm a frustrated internist?

Good post, Fl. I've been seeing more and more narcotic intoxications/OD's in unlikely patients. Not too long ago I had an intentional Vicodin OD from a 65 year old. SHe had just found out she had terminal pancreatic CA with metastasis. She damn near suceeded- it took a ton of Narcan just to get her breathing again. Like I said before- expect the unexpected, and as hard as it may be sometimes, we cannot allow ourselves to get tunnel vision.

Never used it. We have a hypothermia thermometer for rectal use only- that's it. In 25+ years, not once did I ever use it, nor have I ever thought it would help me. With a short transport time, if we know a person has a 100.3, or 97.3 temperature, tell me how this would affect our treatment? Dealing with extremes- hypo or hyer- it's pretty obvious what needs to be done.

I'd also add these factors- Ambient temperature-ie heat related symptoms? Alcohol? Underlying PMH? Compliance with meds? Undiagnosed problems? Drugs(elderly or not, it's still a possibility)? I'd also echo the fact that a person with a glucose level of 260 could easily be in DKA. We'd have no way of knowing. An ABBA type concert doesn't generally sound like a haven for illicit drugs, but you never know. Years ago, I moonlighted at a local venue and the Grateful Dead was playing. Mass chaos, but that's another story. We had a 16 year old girl who worked at a concession stand who was brought to us, exhibiting bizarre behavior. Her friends/coworkers swore this kid was as straight laced as they came. We checked her out, and it turned out one of the "dead-heads" thought it would be funny to slap a plastic sticker on the girl's upper arm, which was probably laced with LSD or PCP. During a lucid moment, the girl recalled having a brief conversation with another girl in the bathroom about 30 mins earlier, and as they parted, she recalls getting a hug from the dead head, which she thought was odd. It must have been the moment the dead head applied the sticker- a Smiley face, of all things. Point is, expect the unexpected in this business.

I've had a lot of experience with heat related problems with heat waves and marathons. Prehospital tx, ice packs, A/C, and dousing with water are the only options we have. Bottom line is unless we get their core temp down, these people will cook themselves from the inside out. IV's- even at room temperature(as in an air conditioned rig) will also help. We don't take temps in the field, but when someone is exhibiting the classic signs, you need to work fast. Depending on how high the temp is, the hospital can do lavages, cooling blankets, etc, but as noted, there is always the danger of causing shivering, which defeats the purpose. Then again, if they become too hot, they can have a seizure, which is much worse than shivering. I do question how much heat that a bit of shivering will generate- maybe there is data that confirms this. I'm thinking the benefit of lowering their core temp may outweigh the extra heat they may generate by shivering. I'll never forget years ago when we had a patient in cardiogenic shock and had rales with mild to moderate SOB, and this was also before the time we had pulse oximetry. Per usual, we had a short transport time. I had a doc(our PMD at the time) suggest we give a fluid bolus to this patient, and I freaked out. I made him confirm that order several times. We complied, it didn't help nor hurt, but when we arrived, I asked for clarification. The doc explained that a couple hundred ml's of saline would have a neglible effect on the fluid overload, but could easily bring up the BP if the person was hypovolemic. If the fluid challenge didn't work, then Dopamine is an option, but setting up a drip would probably have taken too long in our case. My point is, since medicine is an art, not a science, we occasionally see grey areas that may be counterintuitive to what we are taught, and that's when medical control is vital. Clearly, the situation, the patient's V/S, age, PMH, transport times, and protocols dictates your treatment, but someone who is severely hyperthermic is breaking down proteins and headed for renal failure, brain damage, and tons of metabolic issues. The sooner we start them cooling off, the better chance they have to recover.

Why CB- how positively UN-PC of you! (And I happen to agree with you 100%.) I would also add that if we could round up all the other illegals here, we should televise their return as well. We get daily updates of war casualties, why not a daily count of how many illegals we return to their own countries?

Shake the tree. Hard. Get ready to catch him. In all seriousness- I have no idea.

The only thing I will take exception with here is that you are referring to an attitude you project. I don't disagree about having a proper attitude and doing your job to the best of your ability. Whether or not you "make a difference" is highly subjective and dependent on what the patient and/or their family is expecting. Their perception of your actions may be completely different than your intent- good or bad.

Sounds like you definitely have a hostile working environment suit, but it will help those who come after you more than you. I'd say move on- and let the chips fall where they may with the suit. This sounds like far more than simple drama at the workplace stuff- these are illegal actions. Contact the EEOC yourself and see what they tell you.

Been used for years in cardiac surgery and transplants, but obviously that is a controlled setting and very different circumstances. I understand the rationale behind the concept, and it makes sense, but as was mentioned, I think this needs to be more thoroughly studied. I can see it being useful for example when someone may have a refractory electrical problem that needs to be corrected and you need to buy some time. Problem is, too many of our arrests are unwitnessed and the down time is unknown. I see potential, but more data needs to be generated.

While I know that our profession LOVES acronyms and abbreviations almost as much as the military, some of these abbreviations are also unique to a particular area, system, or organization. Some are even specific to a certain country, and we certainly do have members from all across the globe. As such, more than a few times I have needed to do a search to define a poster's terms because I am not familiar with the shortcuts being used. Yes, we are all familiar with ACLS, CPR, and KED's, but I have learned that what I know of as the "Recovery Room" is called the Post Anesthesia Recovery Ward (or something similar) elsewhere. Most of the time it's not difficult to figure out, but some are not so easy to decipher. Suggestion- as with a research paper, for the more obscure terms, could we define or spell out a phrase the first time we use it and then use the acronym, so we are all on the same page? IE: Advanced Life Support (ALS).... Think of it like the National Incident Management System courses (NIMS). We have been taught not to use proprietary terms like 10 codes, or official radio signatures when responding to a large scale mutal aid incident to eliminate confusion at the scene. Similar purpose here. Am I the only one who has a problem with this?

As I pointed out, you contradicted yourself(or apparently wasn't entirely clear) in your post. Your position was NOT clear on the subject, but I apologize if I mischaracterized your opinions. Anyway- I don't think anyone suggests disciplinary action based on an anonymous complaint alone is a good idea. Investigate, get corroborative evidence, make a decision whether or not the complaint is valid, and then decide how to proceed. Like I said, in many cases of public corruption, because of the ingrained culture, an anonymous tip may be the only way someone is willing to blow the whistle on a problem. Fear of retribution and/or retaliation is a very real problem. There is a reason why whistleblower hotlines and anonymous tip lines have become more common these days.

When the problem is because of an entrenched, good old boys network, an anonymous complaint might be the only way something is changed. Whistelblower tip lines have became common in many places for this very reason. If the complaint has no merit, then after an investigation, it is ignored, but dismissing it out of hand is not a good idea. Yes, in a perfect world, it would be nice for everyone to "man up" and sign their name to a complaint, but that's not the way it always works. People fear reprisals, especially when they are in a subordinate position or one that is not part of the majority. I thought you said that you don't give anonymous complaints any credence? Anyway, I think a simple check is worthwhile to see if the complaint has any validity. Consider the source- is the employee reliable? Do you value their opinion? What is their work and/or disciplinary history? What is the employee's relationship to the complainant(peer, subordinate, potential competition for a promotion, etc? For the benefit of your organization, I think if you can keep a little problem from escalating, it's worth the extra effort.

I'm all for it. Tons of money for doing absolutely nothing will make it all better. It's worked well for all the liberal social engineering programs, hasn't it? Oh wait... BTW- what happens when all that money doesn't do a damn thing? Back to square one, right? Then what- back to set asides again, and the cycle starts all over again?

That's the best advice I've seen yet on this. Get it straight from the horse's mouth. They can give you insight into things you may never even have thought of.

Tough situation. If you do not receive support from your superiors when something like this happens, it's a big problem. Because clearly the fire department has the upper hand here, it doesn't look like you will ever get satisfaction or a fair shake. It seems you are changing positions and/or places, which may be the best solution for you. As for changing the status quo- good luck. The only way something like this gets exposed and potentially changed is if something(like a delayed response) bad happens to someone with clout or money. They raise hell and somebody's head will roll. There will always be animosity between fire and EMS- even when they are located within the same department that has single role providers. The old school mentality that a firefighter wasn't "trained to be no doctor" is still prevalent in many areas. Honestly, I think the only thing that will help is time. After a generation or 2 of firefighters are trained as prehospital providers and deal with the reality that the majorioty of their job is NOT fighting fires, the tensions will start to ease. Now, with this economy, even the sacred cow of public safety is seeing cuts. Layoffs, fire companies going out of service, manning cuts all mean that either the business adapts or will be in real trouble. Will this mean fire attempts to exert even more control and/or influence over EMS to save their skins- quite likely. How will EMS respond to these challenges- that remains to be seen.

I think crotchity is right. We need to pay up. Now. Reparations, my friend. Plain and simple. Many firms who had ties to slavery in the 1800's have already been forced to apologize for what their founding fathers did back then. There is even a movement to extort guilt money from these same companies to further punish them for what their founders did. Guess what- if money is what this is really all about and not real solutions, then I'm all for it. Institute a new tax to pay for it- I don't care. Use part of the "porkulous" package money if necessary. Give a million bucks to every black man, woman, and child. If you trace your roots to Germany, Africa, or Ohio- doesn't matter. Can you trace your family back to a middle class lifestyle, noble heritage, or even being responsible for selling slaves to other tribes or the evil white man- irrelevant, It's still lotto time for you. BUT No more set asides, no more affirmative action, no more quotas-NO advantage whatsoever based on race. We're even. Score settled. Done. Account paid in full. The evil white man will pay for something he personally had no part in, but I don't care. Now you work your tail off like everyone else- maybe you succeed, maybe not. Just like everyone else. YOU are now responsible for your own destiny. No more excuses, no more alibis- your accomplishments AND your failures are your own- nobody else is responsible for them. All the credit, and all the blame. Sound like a plan? Who's on board with this? Any chance this will happen-of course not. An entire political party would essentially be out of business. If they can no longer keep someone dependent and convinced they are inferior to everyone else, they lose a significant voting block and they would never let it happen.

This is what it's all about folks: Crotchity said: "you owe us for the damage you caused." There you have it. This isn't about righting a wrong, offering solutions, getting past a horrible time. Paybacks. Plain, ugly, and simple. It will never be enough. No end points, no settlements. Thus, a rational discussion on this is futile.

You have nothing to worry about. You're probably doing more than 99% of providers. I would pay particular attention to your core, and abs, back, shoulders. The problems generally result from repetitive motions over a long time- knees, back, shoulders. Good luck, and thank you for your service.

Good luck with that. I don't know about your area, but the state's attorneys around here are reluctant to file felony charges if we are assaulted unless there are multiple broken bones or other serious injuries. Not a glamorous enough case for them, I guess.